Anemia is a non-specific marker for overall health. In older, non-hospitalized, adults the presence of anemia is associated with >4-fold increase in the hazard of death and a 2.5-fold increased risk of a first cardiovascular specific hospitalization compared to a non-anemic cohort. Non-selective registries of patients presenting with acute coronary syndromes show that between 20 and 30% are anemic. Anemia is associated with greater age, renal disease, peripheral vascular disease, diabetes, and prior myocardial infarction: conditions all associated with poorer outcomes. Also, anemic patients are less likely to receive evidence-based therapy. This is but another example of a risk-benefit paradox where the highest risk population is less likely to receive the treatment potentially most beneficial.